(Name-Based Check - BHR Basic, Volunteer, MVR, or other)

*Information below is being used for background screening purposes only.

KANKAKEE COMMUNITY COLLEGE
DISCLOSURE FOR CONSUMER REPORTS

READ CAREFULLY BEFORE SIGNING

Kankakee Community College ("end-user") has contracted with Bushue Background Screening in connection with my application for enrollment/acceptance into a program. I understand consumer reports will be requested by you the end-user. These reports may include, as allowed by law, the following types of information, as applicable: names and dates of previous employers, reason for termination of employment, work experience, reasons for termination of tenancy, former landlords, education, accidents, licensure, credit, etc. I further understand that such reports may contain public record information such as, but not limited to: my driving record, judgments, bankruptcy proceedings, evictions, criminal records, fingerprint records etc., from federal, state, and other agencies that maintain such records.

In addition, investigative consumer reports (gathered from personal interviews, as applicable, with former employers or landlords, past or current neighbors and associates of mine, etc.) to gather information regarding my work or tenant performance, character, general reputation and personal characteristics, and mode of living (lifestyle) may be obtained.

I understand the end-user can use this disclosure in connection to obtaining consumer reports throughout my employment, volunteer services, contracted service, tenancy, enrollment, etc. with the end-user.

Form B - Disclosure v4.3 - January 2024

KANKAKEE COMMUNITY COLLEGE
AUTHORIZATION FOR CONSUMER REPORTS

READ CAREFULLY BEFORE SIGNING

I hereby authorize procurement of consumer report(s) and investigative consumer report(s) listed in the Disclosure by Kankakee Community College ("end-user") and its consumer reporting agency Bushue Background Screening ("Agency"). In my connection with the End-User, this authorization shall remain on file and shall serve as ongoing authorization for the End-User to procure such reports at any time during, as permitted by law, my employment (or other affiliation) with the End-User. I authorize without reservation, any person, business or agency contacted by the consumer reporting agency to furnish the above-mentioned information.

I specifically authorize the obtaining of the following reports, but not limited to: names and dates of previous employers, reason for termination of employment, work experience, reasons for termination of tenancy, former landlords, education, accidents, licensure, credit, my driving record, judgments, bankruptcy proceedings, evictions, other public records, criminal history records, fingerprint records, etc.

I understand that I have rights under the Fair Credit Reporting Act, and I acknowledge receipt of the Summary of Rights.

I authorize the End-User and the Agency to use email communication with me to provide me with notices and information regarding any report or use of such report. I also authorize the use of electronic signatures. If I do not have an email address or do not wish to share it, then communication will be by U.S. Mail, which will result in slower communication.

If you have any questions concerning this background screening content, please contact: Bushue Background Screening at (217) 342-3042 or info@bushuebackgroundscreening.com.

Form C - Authorization v4.3-January 2024

KCC Health Careers Background Check Form Instructions

1. Preview: Use the "Download PDF for Printing" button below to review your document.
2. Verify: Check for accuracy. If needed, go back to the form to make edits.
3. Download & Print: Click the Download button () in the upper-right corner and then print the file.
4. Sign: Read the agreements and authorizations carefully then sign and date the signature fields on each page.